I want you to close your eyes for a minute and think back to your high school or junior high health education experience. What do you remember?…if anything? More importantly, what “Letter Grade” would you give yourself today, right now, if we did an accurate assessment of your health and well-being?
Anyone not get enough sleep or exercise this past week? Did you pass on the dessert last night? Perhaps you are still searching for the motivation to do something about your stress and anxiety level? Or, is there anyone listening who finds it difficult to make meaningful day to day social interactions with other people? Perhaps you are struggling with substance abuse, or any other detrimental health behavior?
Did your health education experience prepare you for these types of moments?
I can recall my high school and undergraduate health education experience as “content-heavy.” We were lectured to about various health topics and somehow that was supposed to make us become healthier people. Is this really what is best for our students? Today, I want you to think about the term “Health Literacy”
What does “health literacy” mean to you? October is Health Literacy month and it is a time for organizations and individuals (like you and me) to promote the importance of being healthy people. But why not think about health literacy more than just the month of October. According to the U.S. Department of Health and Human Services, health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (1). How do you go about teaching your students what it means to be health literate?
According to research from the U.S. Department of Education, only 12 percent of English-speaking adults in the United States have proficient health literacy skills. The impact of limited health literacy disproportionately affects lower socioeconomic and minority groups (2). Clearly something is not working here.
Simply telling people that they should eat more fruits and vegetables, get more sleep, be more physically active, avoid e-cigarettes, or limit sun exposure does not necessarily mean they will change their behavior.
In the textbook Essentials for Teaching Health Education (3) by Sarah Benes and Holly Alperin, the authors suggest that “you cannot simply use facts and figures in the hope that this information will prompt students to make a healthy choice. Rather, you must only include information that is important for students to learn based on the intended outcome, the skill with which it will be taught and connected to student need.”
Yes, having the knowledge to make a behavior change is important, but it’s much much more than that. It is also having the skills, and even more, the self-efficacy to lead a healthy life. As Benes and Alperin state, self efficacy is the “foundation of human motivation and action. Unless people believe they can produce desired effects by their actions, they have little incentive to act or to persevere in the face of difficulties.”
So, we must build self-efficacy in our students and teach them the health skills necessary to be healthy now and in the years to come.
There are Five Main Goals of a Skills-Based Approach to Teaching Health (Benes & Alperin)
- The first being facilitating learning experiences through which students engage with the content.
- Using a lesson format that supports knowledge and skill acquisition.
- Providing engaging, relevant experiences for students.
- Fostering participation and active learning.
- Providing opportunities for self-reflection, internalization, and personalization of the content (information and skills).
So instead of listening to a boring lecture or reading some cheesy textbook about how you should communicate to your partner regarding sexual health, let me give you an example of how I tried to create a meaningful experience for my 10th graders keeping in mind the five main goals of skills-based health education.
As students walked into class that day, they heard sounds of Italian music and a large image of a pizzeria projected on the screen up front with a warm, delicious looking cheesy pizza. The pizza looked so good you could almost smell it, better yet taste it. Today class, I want you to think of your favorite pizza because you are going to let us know what is the best pizza for you. But, there is a catch, you must work with another person, communicate what kind of pizza you want and come to an agreement on what it is you are going to order. Students were required to think about and discuss the following questions::
- What style of pizza do you like?
- What size? Type of crust? Sauce?
- What toppings?
- Where will you get the pizza from?
- How will you order it? (phone, online, in-person)
- How will you pay? Who will pay?
- Is it for take out, delivery, or dine in?
- Have you eaten this pizza before, or will you be trying something new?
- How much do you envision yourself eating?
- How satisfied do you think you will feel after eating this pizza?
After some discussion (with the intent of using assertive communication) students came to an agreement (or what they deemed to be fair) and I asked “Why Pizza?” We then watched a brief 4 minute Ted Talk clip from the well-known Sexuality Educator, Al Vernacchio where he compares sex to eating a pizza. If you haven’t seen the clip I suggest you check it out, but he argues that Sexual Intimacy should be:
- Internally Controlled
- Invites Exploration
- Promotes Satisfaction
- And that it is not about an external outcome
Hmmm….sounds just like all the characteristics to a safe and fulfilling pizza experience. After viewing the clip the activity became more clear to my students about WHY we did the pizza activity. I had them reflect further and then share comments to the group answering questions such as::
- What was easy about this experience?
- What proved to be a challenge and how did you resolve potential conflict?
- How could ordering a pizza with someone be similar to decision making and communication in regard to sexual health?
- What factors (ie the “toppings”) should go into your decisions and communication strategy when “ordering a pizza” with someone else?
- Lastly, we thought about the internal and external reasons why a person might choose to become sexually active.
In 20 minutes, my students had a participatory interpersonal communicative experience that a textbook or lecture would not come close to accomplishing. All of a sudden the content and skills became relevant to them.
A quality health curriculum should be aligned with the skills of the National Health Education Standards (and your state standards) and focus on students developing competency (or proficiency) in them so students are able to engage in health enhancing behaviors, avoid risky behaviors, and be healthy, productive people. This idea became incredibly clear to me when Sarah and Holly used the analogy of the Health (or even PE teacher) as a coach. If you think of the health education teacher as a coach, then you should teach your athletes the skills necessary to be successful in the game. If we want students to develop the necessary skills to be health literate (or in the case of PE, physically literate) beyond high school, then we will need to teach them how and give them time to practice in order to develop skill proficiency.
So, you might be asking, what are these skills you are talking about? They come from the National Health Education Standards and include the following:
- Accessing valid and reliable information, products, and services
- Analyzing influences
- Interpersonal communication
- Decision making
- Goal setting
Where in your curriculum can you infuse more skill development? Perhaps your units become the skills mentioned above and you teach about the content using those skills. Can you find opportunities to start to shift away from “content units” and incorporate more “skill development.” For example, you can teach students how to set an effective health goal and have them practice the action steps necessary to achieve it. Another example would be having students use the DECIDE decision making acronym and have them apply it to different decisions they will have to make that affect their health.
Or, you can have students choose a health topic they are curious about and have them advocate for why we should care about a particular topic within their community. Have students work on interpersonal communication such as refusal skills and practice what they could say in different scenarios regarding peer pressure. Role playing is “practice”. Learning these skills are more important than knowing the chemicals found in e-cigarettes for example. The drug of choice (content) will change, but I am confident the skills to deal with it will remain the same. I encourage you to think about your own practices and how you teach students what it means to be health literate. Health literacy is a life-long journey and not a destination. As a adults, we continue to make decisions every day that impact our health in a MORE healthy or LESS healthy way. Giving our students the tools through engaging experiences to help them navigate their own health literacy journey is critical in whether or not they succeed in their years after high school.
Our work as health and physical educators is incredibly important. By providing quality health and physical education, it will only make our profession STRONGER and convince the powers that be….why we matter for students.
We are all co-authors and co-creators to making our profession what we want it to be. As you think about teaching your students the HOW and WHY to health literacy, just remember During this process, make sure you celebrate the small wins…because small wins lead to momentum and momentum leads to change…which ultimately makes our profession stronger than it was the day before.
That is why I was inspired to write a song to hopefully help YOU become inspired to do YOUR job just a little bit better than the day before. I now invite you to listen to the song entitled “Stronger”.
Thank you for listening.
1U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.
2Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: U.S. Department of Education, National Center for Education Statistics.
3Benes, S., & Alperin, H.. (2016). The Essentials of Teaching Health Education. Champaign, IL: Human Kinetics